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an online version of the magazine Fall 2009
Circling the Dome
Circling the Dome
Ready for their close-up: Carol Greider posed with her two kids—Gwendolyn, 9, and Charles, 13—in advance of the formal Nobel festivities in Stockholm on December 5.
Photo: AP Photo/Rob Carr
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The Nobel’s New Glow

Through Carol Greider, science’s biggest prize shines a light on the next generation.

 

From the press conference’s opening moments, it quickly became clear this was not going to be your father’s Nobel Prize. First off, the laureate was a mother, a fact made apparent as she entered the auditorium with her two children in tow. Even as the room’s 20 big cameras quickly homed in on the celebrated scientist, they also took in Charles, 13, and Gwendolyn, 9, sandy-haired school kids sprung from their weekday classes. After a beaming Carol Greider shook a few dozen hands and settled into the front row’s center seats, university president Ronald Daniels gave her young ones an immediate nod, playfully noting, "There are going to be a few more duties around the house, as befits the home of a Nobel laureate."

To be sure, that first announcement in early October hit all the right notes. An ebullient Daniels hailed Greider as the newest in a line of 33 Hopkins laureates, dating back to Woodrow Wilson’s turn with the 1919 Peace Prize. Medicine’s Chi Dang, vice dean for research, followed by associating Greider with the recent crop of Hopkins Nobel-winning scientists, including Daniel Nathans, Hamilton Smith, and Peter Agre. Dang even neatly cited Greider’s actual discovery from the podium. "Carol asked one of biology’s biggest questions of one of its smallest organisms," he said, alluding to Greider’s work with the single-celled Tetrahymena, through which she discovered the action of an enzyme her group named telomerase. The enzyme was crucial in maintaining the length of a cell’s telomeres—fundamental elements of healthy chromosomes.

When it was Greider’s own turn at the podium, she generously extended the moment to all of her colleagues worldwide, calling this year’s Nobel "a tribute to curiosity-driven basic science."

Still, there was something distinctive about this year’s winner: namely that her children would be sharing the limelight. "How many men have won the Nobel in the last few years?" she would later ask rhetorically in a New York Times interview, "and they have kids the same age as mine, and their kids aren’t in the picture? That’s a big difference, right? And that makes a statement."

As if to amplify the statement, 2005 laureate Peter Agre chose the press conference venue to build a bridge. While the cameras closed in on Greider—leaving Charles and Gwendolyn to fend for themselves—Agre moved in and handed his cell phone to Charles. Agre had placed a call to his youngest daughter, Carly, and proposed that she offer some advice to the new laureate’s offspring.

"She said we would meet the president and ride in a limo in Stockholm," Charles reports. "She also said it would be a week of fun, with formal balls and events." "They sounded a bit overwhelmed and in disbelief," says Carly Agre. "I know I felt the same exact things six years ago."

— Ramsey Flynn



Expanding the Boundaries of Care

Reaching out to more uninsured and underinsured patients.

 

Last December, Nellie Bell began an uncertain medical journey when a sonogram revealed that her fibroids had grown. She and Deborah Martin, her gynecologist at the East Baltimore Medical Center (EBMC), agreed that a hysterectomy would be the best course.

But how would the 56-year-old day care provider pay for it? Bell made just enough money to support herself and her 5-year-old grandchild. As a self-pay patient at EBMC, Bell faced the classic health insurance dilemma: too much income to qualify for Medicaid but not enough to buy reliable coverage on the open market.

She was rescued by a six-month-old program that helps uninsured and underinsured patients receive specialty health care at Hopkins Hospital. Thanks to The Access Partnership (TAP), Bell finally had a hysterectomy in August. When that surgery revealed leiomyosarcoma, a rare cancer that affects certain muscle cells, the partnership also arranged for her to see a cancer specialist. Bell is receiving chemotherapy at Sidney Kimmel Comprehensive Cancer Center.

Before Hopkins launched the program last May, EBMC patients like Bell could not get diagnostic tests and other special care recommended by their primary care physicians because they could not afford to pay in advance. Now qualified patients pay a one-time fee of up to $20 for a referral and receive no additional bills. "The people here at EBMC have all been like angels to me," she says. "This program has been a blessing."

All Hopkins specialty physicians donate their services to the program, which was created in response to a proposal by Hopkins’ East Baltimore Community Clinic Task Force. Formed after the closing of the Caroline Street Clinic for the Uninsured in 2006, the group of physicians, administrators, and medical students set out to determine how Hopkins Medicine could best serve its uninsured neighbors who demonstrated financial need.

One recommendation was to place them in primary care clinics, such as EBMC, that already serve low-income residents. Another was to improve these patients’ access to Hopkins specialty care. Cardiac surgeon William Baumgartner, president of the Clinical Practice Association, chaired the committee that led to TAP’s creation. Since it started, the fledgling program has proved so successful that it has expanded from covering EBMC patients living in two ZIP codes to three more. Roughly 1,130 patients who live near the East Baltimore and Bayview campuses are now eligible.

Not only does TAP bridge a crucial medical gap, but it also teaches internal medicine residents primary care that is careful and cost-effective. Barbara Cook, medical director of the partnership, makes sure that referring physicians try standard treatments before calling specialists.

She denies requests for MRIs for back pain unless records show that physical therapy, analgesics, and other conservative measures did not work. She has also refused four sleep study requests.

"If a person weighs 300 pounds and is snoring at night, you can pretty safely say that they have sleep apnea," Cook says. "But if they can’t afford the equipment they need to treat it, why pay the money to do a study? Instead, what the patient really needs to do is to lose weight and try other things to improve sleep hygiene."

"Before TAP, I don’t know how we would have taken care of Nellie," says nurse practitioner Pam Mahoney, Bell’s primary care provider. "It would have been very difficult for her to get a hysterectomy."

The Access Partnership, says Mahoney, "makes you feel like you can finally do what you’re supposed to do."

— Linell Smith

 

 


Dinosaur Doc

Steven Cunningham has a penchant for prehistoric creatures—and poetry.

 

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Dinosaur Doc
Isaiah Ellis gets a crash course in dinosaurs, compliments of surgeon-poet Steven Cunningham.
Photo by Keith Weller

When he’s not holding a scalpel, surgical fellow Steven Cunningham pens children’s poetry. The bilingual father of four is author of the English and Spanish Dinosaur Name Poems / Poemas de Nombres de Dinosaurios. The whimsically illustrated book—translated into Spanish by his wife, Myriam Gorospe, a senior investigator at Hopkins Bayview—won the 2009 Moonbeam Children’s Book Award in both Children’s Poetry and Spanish Language Book categories.

Inspired by Cunningham’s dinosaur-obsessed son, the 70-page paperback tackles dinosaurs alphabetically (Allosaurus to Velociraptor), using fanciful prose that plays on their names. Rich watercolor images reinforce Cunningham’s mostly rhyming verse.

Cunningham recently visited the Hopkins Children’s Center to read to 6-year-old Isaiah Ellis. "Stegosaurus," Cunningham informed his captivated subject, "means plated lizard," and then he began reciting the book’s opening poem:

"Plated Lizard," I know that you’re an herbivore
And would not eat a child like me,
Since you prefer the forest floor,
And munching plants like broccoli.


— Judy F. Minkove

 


Walking—and Talking—in Their Shoes

A new elective gets med students out and about the hospital.

 

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Walking and Talking
Medical student Sujay Pathak (right) on the floor with Hopkins nurse Karen DeFilipo.
Photo by Stephen Spartana

One of the most critical innovations in health care may not be a new wonder drug or high-tech surgical tool—but an improvement in the simple act of communicating. "In the culture of health care today, providers aren’t encouraged to speak up," says Sujay Pathak, a second-year School of Medicine student. He saw firsthand how communication issues allowed information to slip through the cracks during his own mother’s hospital care, and eventual death, in 2008.

So Pathak set out to improve the system by creating a new course, "The Hospital." It debuted as an elective here last spring and aims to show aspiring physicians what health care colleagues do by having med students do their jobs with them. Across a broad swath of health care roles—acute and intensive care nursing, social work, rehabilitation, home care, administration, and others—medical students spent a day (or night) on a shift with a seasoned pro in 10 completely different fields.

"We wanted to walk in their shoes, to experience a day in the life of these people," Pathak says, "and to get involved in doing their jobs as much as we could." The course is believed to be the first of its kind in the nation to connect doctors and other medical staff in this way.

"Sujay epitomizes what is great about Hopkins students and the university," says Peter Pronovost, Hopkins’ renowned health safety advocate and Pathak’s mentor. "He wanted more. He wanted a better understanding of how the hospital works. He felt that he and his fellow students needed deeper understanding of the roles of nurses, pharmacists, and others who work in the hospital." So Pronovost encouraged the then first-year student to develop a course, and threw his support behind the project when Pathak approached various heads of Hopkins divisions. They replied with enthusiasm and generous offers to help (Karen Haller, vice president for nursing and patient care services, stepped up as course co-director); the class ended up being entirely handled by volunteers.

For Pathak, the elective needed to be all about on-the-job education. "I was adamant that this not be a didactic experience," he says. "I wanted students to have a low-pressure and fun experience, but one that would teach them valuable lessons."

Medical student Melanie Schorr was one of four fourth-years who enrolled in the course. "For me, the home care nursing was really interesting," she says. "I think many of us did not really understand what home care entails, what legwork and hours it requires. It’s a very different feeling walking into a patient’s home, where they’re more comfortable and speak more openly about their condition and themselves."

Pathak was paired with experienced acute care nurses Giovanna Castellano on Nelson 8, Karen DeFilipo in the Weinberg ICU, and Sara Fore on CMSC 4. During his shift, he saw firsthand the wide variety of skills and talents that good nurses bring to patient care, he says, ranging from small things—"the degree of expertise that nurses have with administering insulin in response to blood sugar changes"—to more strategic decision making. "The masterful skills of diplomacy that nurses must employ when it comes to being a go-between between patients and physicians" was a discovery, Pathak says.

Thanks to positive feedback, "The Hospital" will be reprised in 2010. For Schorr, the big take-home lesson? "A little bit of extra communication goes a long way for patient care."

— Geoff Brown

 


The Journey of Jacob Puka

A technologist in training was once one of the "Lost Boys of Sudan."

 

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Jacob Puka
Puka has found his way.

There is more that differentiates Jacob Puka from his classmates than his lilting voice and precise diction. Although he conducts radioactive scans and creates electronic reports for physicians just like other nuclear medicine technology students, his road to Hopkins seems miraculous, even to him.

Puka, 29, is one of the "Lost Boys of Sudan," the name given to nearly 3,800 young men who were brought to the United States in 2001 after years in refugee camps. When he was just 7, the army raided his small village in southern Sudan; Puka’s father sent his son fleeing into the jungle with a cousin, uncle, and a stream of panicked villagers. It was the beginning of a 12-year, three-camp odyssey that covered nearly a thousand miles on foot, a march marked by peril. The berries on the trees could sustain—or poison. The men just under that next tree could be friends—or armed soldiers. If Puka’s band of travelers hadn’t chanced upon friendly rebels and Red Cross care packages, they would have died.

Puka’s journey from refugee to Hopkins student was sustained by people determined to maintain a sense of dignity and normality in the most difficult of conditions. After fleeing his village in 1987, Puka landed in an Ethiopian refugee camp. Surprisingly, however, his education continued. Classes, he says, were held under a tree. "The sand at your feet was the blackboard for learning the alphabet."

An outbreak of civil war forced Puka out of Ethiopia, back into Sudan, and then into Kenya. In time, a few secondary schools were built, and Puka was one of the few refugees chosen (out of the 75,000 Sudanese in camp) to attend. He focused on the sciences.

In 2001, he was told that he was going to someplace called America, where Catholic Charities had found manufacturing work for him and his fellow Lost Boys. A family gave Puka and other Sudanese living quarters so they could attend Point Loma Nazarene University. Puka graduated with a biology and chemistry degree. He intended to become a physician’s assistant, which required at least 1,000 hours of hospital work. A friend in Baltimore helped land him a job at Anne Arundel Medical Center.

It was there, wheeling patients down to get CT scans and MRIs, that Puka’s attention turned to the 14-month nuclear medicine technology program at Hopkins, which combines theoretical training with hands-on clinical experience. "If you had told me that one day I’d go to school at Hopkins and take care of people with cancer and broken bones, I would not have believed you," he says.

— Mat Edelson

 


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Trailblazers

Innovative minds, pioneering ideas.

 

Trailblazers
Zhang (left) and Jain
Photo by Keith Weller

When giving major research awards, the National Institutes of Health makes a fine distinction between pioneers and innovators. The NIH defines pioneers as "individual scientists of exceptional creativity who propose pioneering — and possibly transformational approaches" in biomedical and behavioral research. Innovators are "exceptionally creative new investigators who propose highly innovative projects that have the potential for unusually high impact."

Despite the definitional nuances of their status, both Jin Zhang, a newly proclaimed NIH Pioneer, and Sanjay Jain, an NIH Innovator, clearly share a key attribute the NIH values: a trailblazer’s ability to conceive of and pursue unique approaches to challenging scientific questions of immense importance. Their skills have earned them awards totaling $4 million for separate research initiatives.

Zhang, an associate professor of pharmacology, was one of just 18 winners nationally of an NIH Director’s Pioneer Award. It provides $2.5 million in direct funding over five years to continue her development of a novel technology for venturing inside cells and manipulating single molecules in them. According to Philip Cole, head of the Department of Pharmacology and Molecular Sciences, Zhang’s research "has already revolutionized our understanding of how cells process information." He says, "With the NIH Pioneer Award, she has the potential to gain unprecedented precision in activating molecules inside the cell and pave the way for new cures for a range of diseases, including cancer, heart disease and immune disorders."

Jain, an assistant professor of pediatrics and director of the Center for Infection and Inflammation Imaging Research, has received one of the 55 NIH Director’s New Innovator Awards for 2009. It provides $1.5 million in direct funding over five years to continue his research employing an imaging technique he designed to monitor in real time the drug-evading behavior of tuberculosis bacterium in test animals.

"Worldwide there are some 9.2 million new infections with TB each year," Jain says. "New drug combinations are needed fast to treat increasingly resistant strains of the bacterium." Jain and his colleagues developed a "designer" strain of TB that absorbs radio-tracing chemicals. The chemicals light up the germ and any infected tissues in the lungs of mice, allowing an image to be captured by CT, PET, and SPECT scanners. The researchers thereby can determine far more quickly how the infection responds to treatment. This new method for studying TB "should accelerate our assessment of whether a treatment is working or not," Jain says.

 — Neil A. Grauer

 


IT Insights

New journal highlights pitfalls—and potential—of medical informatics.

 

IT Insights Kim (left) and Lehmann
Photo by Keith Weller

Despite all the wonders promised for the application of information technology to medical practice—increased efficiency, cost savings, improved patient safety—"health information technology implementation is fraught with a really high failure rate," says neonatologist Christopher Lehmann, associate professor in pediatrics and director of clinical informatics. "A lot of tools implemented today fail before they’re ever used," he adds, citing the computer calamity that Kaiser Permanente sustained in 2003. "They invested more than $400 million in electronic health records and then scrapped it."

Lehmann and his longtime collaborator, George Kim, a research associate in pediatrics and health sciences informatics, want physicians and health care systems to know about the pitfalls—as well as the positive potential—in the exploding field of health care provider computer programs. They have launched a new online, quarterly medical journal, Applied Clinical Informatics (www.aci-journal.org), devoted to original research and commentary on the use of computer automation in the daily practice of medicine. It is the official publication of the International Medical Informatics Association. "We want to bring the case report back," says Lehmann. "We want to present a problem, a case report of an IT need or an IT system that was malfunctioning; have an analysis of the possible solutions to this; and a conclusion" that will enable readers to learn from some other health provider’s mistakes in IT implementation.

Lehmann, the journal’s editor-in-chief, and Kim, the managing editor, have experience with online publications—and even those printed on old-fashioned paper. They’ve just co-authored a book, Pediatric Informatics; and Lehmann was one of the founders of Dermatlas, a dermatology image atlas launched in 2000 that now receives 10,000 views a day. He is also an editor of eNeonatal Review, founded in 2003.

Their efforts have been recognized. Last fall, the American Medical Informatics Association gave Lehmann its 2009 Leadership Award for his work on behalf of its mentorship program. He also was elected secretary of the 4,000-member group’s board of directors.

— Neil A. Grauer

 

 
 
 
 
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